November 9, 2012
Nursing Home Is Faulted Over Care After Storm
By MICHAEL POWELL and SHERI FINK

Hurricane Sandy announced itself by tossing a section of Boardwalk against the Promenade nursing home in Rockaway Park, Queens, blowing out its windows and sending waves washing through the first floor.

On the sixth floor, Kevin P. Johnson, 58, who has a crippling brain disease, saw his television flicker off. “I thought to myself, ‘That’s O.K., the backup generator will kick in,’ ” he said.

It did not. Promenade’s generator was on the ground floor, which quickly filled with swirling Atlantic brine at high tide on Oct. 29. As waves slammed against the building for hours, patients remained inside in the dark, growing steadily more hungry and cold.

The kitchen had flooded, and the owners had not stocked enough food, staff members say.

Amid the worst hurricane to hit New York City in nearly 80 years, the home, the Promenade Rehabilitation and Health Care Center, failed to provide the most basic care to its patients, according to interviews with five employees, federal, city and hospital officials, and shelter directors.

Although nursing home officials say they cannot be blamed for what happened, the State Health Department has opened an investigation into Promenade’s actions.

Cold, thirst, fear: The situation grew so dire that the next evening, as the vestiges of the storm blew across the peninsula, ambulances arrived, evacuated the nearly 200 patients over several hours and deposited them in emergency shelters in the city.

In most cases, no Promenade staff member accompanied the patients, and many patients traveled without their medical records. Both are violations of state regulations.

Some family members are still desperately searching for their loved ones, with no help from Promenade, at 140 Beach 114th Street. These patients now live in various emergency shelters or have landed in cots and beds in hospitals and nursing homes across the region.

“We watched the television: the rain, the fire, it seemed like everything was burning down in the Rockaways,” said Kenneth A. Johnson, who is the guardian for his sick brother. “We called and called and called, but no one at Promenade picked up or ever called us back.”

It is not known how many Promenade patients remain lost to relatives.

Interviews with employees indicate that Promenade failed to carry out basic responsibilities, including adding staff for the storm as required by the state, stocking enough medicine and flashlights, and preparing patients’ records in case of evacuation. The nursing home administrator, who runs the home day to day, left the city — on what he said was a “personal matter” — on Oct. 28, as the hurricane approached. The nursing director left the next afternoon to check on her sick husband; she did not return until Oct. 30, after the storm had blown over.

“My only priority is patient safety and health, and everything you’ve asked about Promenade flies in the face of that,” said the state health commissioner, Dr. Nirav R. Shah. “We are investigating aggressively.”

Still, there are questions about the state’s handling of the situation, too. A year ago, when a less-powerful Tropical Storm Irene loomed, Dr. Shah ordered many nursing homes in the Rockaways to evacuate. But he declined to do so last week in the face of Hurricane Sandy, even though the nursing homes lay in an evacuation zone. Dr. Shah said he gave the homes the option of not evacuating, based on the risks of moving the elderly and the frail. Also, nursing homes complained bitterly about the cost of evacuations last year.

Most of those nursing homes, even those much better prepared than Promenade, suffered crushing damage from the storm, and most have since evacuated their patients.

This is not the first time that Promenade’s response to a storm has raised alarm: Last year, when the storm began to blow onshore, Promenade was dangerously slow to react, state officials say, and sent its patients off without staff members and often without medical records. The State Health Department did not investigate or fine Promenade in that case.

“It was absolute chaos; everyone was crying,” said Dionne Keisha Vanable, a nurse and longtime employee.

As the storm approached last week, the State Health Department ordered all nursing homes to stay at 150 percent of normal staff levels, to stock three days’ worth of food and medicine, and to make sure to have a working generator in case power failed.

Promenade’s owners — Moses Vogel, his son Solomon Vogel and at least one other partner — have run the home since the 1970s. In two interviews, Solomon Vogel blamed the storm and state officials for the nursing home’s problems. He said the home had increased its staffing for the storm to 150 percent and had enough medicine, flashlights and food.

“What was crazy is the New York State Department of Health told us not to evacuate before the storm, so we sheltered in place,” Mr. Vogel said. “I had to call them about 100 times before I was able to get the Office of Emergency Management to get them out,” he added, referring to the New York City agency.

He suggested that Promenade should be commended for carrying out a safe evacuation in a blackout after a huge storm. “That everyone got out safely was unbelievable,” he said.

But Dr. Shah and four Promenade workers dispute nearly every one of Mr. Vogel’s assertions. In the days leading up to the storm, Dr. Shah noted, “I was talking to managers in just about every facility except Promenade. Not only did we not hear from them; we actively tried to contact Promenade” and heard nothing.

Promenade nurses said the home was short of medications and food. Nurses began to make lists of patients and relatives to contact, but one nurse said that an owner told them over a loudspeaker to stop, as he intended to ride out the storm.

“I was told to pull face sheets for patients on Sunday, and there were all sorts of holes in the records,” said the nurse, Alana Steele, referring to the patients’ documents that contain vital information, including which medications they take. “Whenever I work there, I worry about my license and my liability.”

A nursing home sits on either side of Promenade. Each had a generator placed off the ground or walled-off from the water. Promenade’s generator, by contrast, sat closer to ground level.

As for supplies, Edwin Delgado, the facilities director at the neighboring Ocean Promenade Nursing Center on Beach 113th Street, which is not connected with Promenade, recalled that Solomon Vogel came running over on the day of the storm.

“He demanded we give him some flashlights and batteries,” Mr. Delgado said.

Ms. Vanable worked the overnight shift at Promenade during the storm, and she recalled they had a bare complement of nurses and were short on aides.

“We never have extra staff, never — storm or no storm,” Ms. Vanable said.

She described the scene in the building on Monday night as the hurricane hit, the waters rose and the Promenade fell dark. Emergency lights never came on.

“It was scary; we were all petrified,” Ms. Vanable said. “We tried not to show that to the patients.”

The kitchen flooded, and food ran short. Some workers failed to show up for assigned shifts. Early Tuesday morning, the staff in Park Nursing Home took pity and slapped together 150 sandwiches for the staff members and patients of Promenade.

Promenade was dank and cold, and without lights. Dr. Shah, the health commissioner, asked for help from the hospitals of North Shore-LIJ Health System, which sent two safety officers out to the Rockaways at first light that Tuesday. Every street the officers tried was blocked by floodwaters or fire trucks fighting a blaze several hundred feet from the nursing home.

They returned several hours later, and Tuesday night, a caravan of ambulance crews showed up to evacuate patients. Emergency Medical Service crews struggled to carry wheelchairs and patients with severe dementia down the stairs to waiting ambulances. But some records and medications did not follow.

“Some records went with the wrong patients to other sites,” said Brenda Stratten, a nurse in charge of the federal Disaster Medical Assistance Team based at the emergency shelter at Lehman College in the Bronx. “I had a few patients where more records arrived Day 2 and 3.”

The ambulances took Promenade residents to several different shelters. Slightly more than 100 patients were placed in four dimly lighted classrooms at Brooklyn Technical High School in Fort Greene, Brooklyn. Few of these patients, according to one federal and two city and officials who were there, had medical face sheets or proper medications.

Federal and city emergency workers grew so concerned that they conducted finger-stick and other blood tests on some patients, they said.

“It was as if they had been abandoned,” said a worker at the Brooklyn Tech shelter, who spoke on the condition of anonymity because he had been told not to speak to reporters. “The shelter staff worked heroically, but they were completely in the dark.”

Later, on Oct. 31., Promenade staff members appeared at the shelter, greeting their patients with great hugs and helping to care for them. Within five days, however, Promenade had temporarily withdrawn these familiar faces from the shelters, saying it was too expensive to pay them, other shelter workers said.

In the days to come, the sickest of Promenade’s patients were farmed out to nursing homes across the region. Broadlawn Manor Nursing and Rehabilitation Center, 30 miles away in Amityville, N.Y., received 10 Promenade patients on Nov. 1. They arrived with medications but missing papers including instructions for end-of-life preferences.

For a week, Broadlawn social workers tried to reach Promenade. Finally, on Wednesday, nine days after the storm first hit, a Promenade social worker called and promised more information.

“That’s the last we heard,” said Terry Lynam, a spokesman for North Shore-LIJ Health System, which owns Broadlawn.

Relatives of patients described similar frustrations as they tried to get in touch with Promenade, efforts run through with anxiety and fear.

Some remain in limbo. Lillian DiViesti, with help from her son, Paul, has searched more than a week for her mother, Marie Salatino, a 93-year-old retired union seamstress from Sheepshead Bay, Brooklyn, who is blind and has dementia.

Promenade called the day of the storm and said they were not evacuating. “We haven’t heard from them since,” Paul DiViesti said. The family dialed the nursing home, city agencies, the police and 311.

The State Health Department has not yet completed a database that would help family members find loved ones. Louisiana put in place such a system in 2008 after Hurricane Gustav.

Mrs. Salatino remains lost in the storm’s diaspora.

In an interview with The New York Times, Solomon Vogel said on Thursday that he would check his database and get in touch soon. “We have two social workers working full time contacting family members about the locations of their loved ones,” he said.